Key Points
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Intervertebral disc (IVD) degeneration is frequently associated with low back and neck pain
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The avascularity of the IVD is an obstacle to intrinsic repair by exogenous cells
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Tissue-specific progenitor cells have been identified in the IVD, and these cells could be targeted to promote intrinsic repair
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Supplementation of functional cells from exogenous sources has IVD-regenerative effects in basic and preclinical studies
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A growing number of clinical trials are assessing the effects of cell therapy for IVD disease
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Despite promising results of cell therapy for IVD disease in preclinical studies, various obstacles remain to define its efficacy and target indications
Abstract
Intervertebral disc (IVD) degeneration is frequently associated with low back and neck pain, which accounts for disability worldwide. Despite the known outcomes of the IVD degeneration cascade, the treatment of IVD degeneration is limited in that available conservative and surgical treatments do not reverse the pathology or restore the IVD tissue. Regenerative medicine for IVD degeneration, by injection of IVD cells, chondrocytes or stem cells, has been extensively studied in the past decade in various animal models of induced IVD degeneration, and has progressed to clinical trials in the treatment of various spinal conditions. Despite preliminary results showing positive effects of cell-injection strategies for IVD regeneration, detailed basic research on IVD cells and their niche indicates that transplanted cells are unable to survive and adapt in the avascular niche of the IVD. For this therapeutic strategy to succeed, the indications for its use and the patients who would benefit need to be better defined. To surmount these obstacles, the solution will be identified only by focused research, both in the laboratory and in the clinic.
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Acknowledgements
The authors are grateful to M. E. Lenz for her help in preparation of the manuscript. This work was supported in part by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, a grant from AO Spine International and a grant from AO Foundation (D.S.).
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Sakai, D., Andersson, G. Stem cell therapy for intervertebral disc regeneration: obstacles and solutions. Nat Rev Rheumatol 11, 243–256 (2015). https://doi.org/10.1038/nrrheum.2015.13
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DOI: https://doi.org/10.1038/nrrheum.2015.13
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Journal of Nanobiotechnology (2023)
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Degenerated nucleus pulposus cells derived exosome carrying miR-27a-3p aggravates intervertebral disc degeneration by inducing M1 polarization of macrophages
Journal of Nanobiotechnology (2023)
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Single-cell RNA sequencing in orthopedic research
Bone Research (2023)
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Enhancing Cell Migration on Polyetherimide-Grafted Fe3O4@SiO2-Labeled Umbilical Cord-Derived Mesenchymal Stem Cells Arrests in Intervertebral Disc Regeneration
Journal of Cluster Science (2023)